Term
| how does myasthenia gravis effect normal motor function? |
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Definition
There is decrease efficiency of neuromuscular transmission in M.G.
Decreased # of Ach receptors on muscle endplate
Distortion of post-synaptic membrane
Autoimmunie disorder produces anti-ACh receptor antibodies (blocks the binding site, damage to the postsynaptic muscle membrane |
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Term
Is myasthenia gravis the most common neurmuscular transmission disorder?
What type of disease is M.G. and what the the characteristics of it? |
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Definition
Yes
Autoimmune disease characterized by:
Fluctuating muscle weakness
Farigability of skeletal muscles |
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Term
What is the ratio of w/M that get Myastenia Gravis?
What is the typical onset of M.G.?
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Definition
W/M: 3:2
20s and 30s for women
After 50 and 60s for men |
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Term
| What immune system organ is effected in Myasthenia Gravis? |
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Definition
| The Thymus has abnomalities in 75% of people with MG |
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Term
| What are some of the clinical manifestations of Myasthenia Gravis? |
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Definition
Fluctuating skeletal muscle weakness
Fatigability:
Repetion cause fatigue
Rest restores activity
Besides weakness, neurological finding WNL |
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Term
| What are the classifications given for Myasthenia Gravis? |
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Definition
Ocular
Mild generalized
Acute Fulminating (coming on suddenly with great severty)
Late Severe |
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Term
| What is the distribution of muscle weakness in Myasthinea gravis? |
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Definition
only ocular muscles
or
Generalized muscle weakness 85% of the time |
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Term
| Fluctuating weakness often more noticeable in what muscles, prox or distal? |
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Definition
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Term
OF the cranial muscles what muscles are usually effected first in Myasthine gravis?
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Definition
| eyelid and eye movements usually affected first |
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Term
| What is the result of the eye muscles being effected in M.G.? |
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Definition
Diplopia (double vision)
Ptosis (drooping eyelids)
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Term
| In myasthenia gravis are reflexes and sensations normal? |
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Definition
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Term
| when looking down to up in a normal position both eyelids are seen to overshoot in a twitch like fashion then return to the ptosis position, T/F? |
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Definition
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Term
| If there is superior rectus plasy of the eye a sustained upward gaze of the patient will do what? |
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Definition
| The ptosis of the eye will increase |
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Term
| What are some dx symptoms of Myasthenia Gravis? |
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Definition
History
Clinical observation of weakness with continued use and improvement with rest
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Term
| What differential dx techinques can be used with Myasthenia gravis? |
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Definition
Drug-induced myastenia
Hyperthiroidism
otulism
Intracranial mass lesion
Progressive disorders of the eye |
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Term
| What are some test that can be done in order to help dx Myasthenia Gravis? |
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Definition
Imunologic Testing- to detect ACh receptor antibodies in blood (spec but not sensitive)
Pharmacologic testing with Tensilon: an AChEsterase inhibitor
Electrophysiologic testing |
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Term
| What is the purpose of Pharmacologic testing with Tensilon: an AChEsterase inhibitor? |
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Definition
The the enzyme inhibited that breaks down ACh allows ACh more time to find a working receptor increasing muscle function.
THis would lead Dr to believe that the person does have M.G. |
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Term
| Electrophysiologic Testing in Myasthenia gravis does what? |
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Definition
| Normal EMG at rest with a rapid decline in amplitude of AP with repetitive stimulation |
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Term
| How is Myasthenia Gravis Medically managed? |
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Definition
AChE inhibitors:
Improvement of weakness
Does not tx underlying causes
Side-effects: see slide
Toxicity
Immunosuppression:
Corticosteroifs (prednisone/Azathioprine)
side effects- weight gain, hypertension, osteoporosis
Plasmaphoresis- short term effects only
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Term
| what is the danger of using AChE inhibitors in Myasthenia Gravis? |
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Definition
| high doses produce CNS stimulation gollowed by CNS depression, in addition to a depolarizing neuromuscular blockage and may result in respiratory depression, paralysis, death |
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Term
| What is the prognosis for Myasthenia Gravis? |
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Definition
Slowly progressive course
course of the disease is variable:
can be a long term spontaneous relapse that can last for weeks
remission are rarly complete or permanent |
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Term
| Myasthenic Crisis is a what and is characterized by what? |
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Definition
A medical emergency
Increasing muscle weakness
Respiratory distress*
Difficulty talking, chewing, swallowing
Weaking of respriatory muscles requires ventilatory assistance |
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Term
| What is the PT's role when dealing with a patient with Myasthenia Gravis? |
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Definition
Suportive care to assist patient with myasthenia gravis
Prefeered practice pattern 4E- impaired muscle performance
Deep breathing and coughing exercises
Positioning during meals- dysphagia
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Term
When can strength training be done with patients with Myasthenia Gravis?
What type of exercise can be done? |
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Definition
Patients with mild to moderate myasthenia gravis
maximal isometric contractions
Below fatigue level
Improvent in all muscles shown |
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Term
| What are important points of paitent education for those w/ myasthenia gravis? |
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Definition
Side effects and signs of toxicityof AChe inhibitor meds
Teach to plan activities during periods of max energy
Enegy conservation tips:
arrange home to prevent unnecessary energy expenditure
Frequent rest periods
Avoid:
strenuous exercise
stress
excessive exposure to sun or cold weather |
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